{"id":42560,"date":"2018-07-10T10:50:37","date_gmt":"2018-07-10T09:50:37","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=42560"},"modified":"2018-07-17T13:43:23","modified_gmt":"2018-07-17T12:43:23","slug":"matthew-roycroft-training-matters-tel","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/07\/10\/matthew-roycroft-training-matters-tel\/","title":{"rendered":"Matthew Roycroft: To TEL or not to TEL"},"content":{"rendered":"

TEL has many uses, but high quality mentoring and supportive relationships must remain the backbone of medical education<\/p>\n

\"MatthewTechnology enhanced learning (TEL) has expanded rapidly over the past decade. Learning with a technological element to it, such as e-learning or simulation, is now a regular part of continuous professional development; undergraduate and postgraduate medical education; and, for many clinicians, it\u2019s also part of day to day practice.<\/span><\/p>\n

It’s generally acknowledged that \u201ctechnology offers real benefits and opportunities to support and enhance the delivery of excellent healthcare education<\/a>,\u201d<\/span>\u00a0but I think we are reaching the point where there\u2019s a danger of taking this too far. A trainee isn\u2019t able to get to a teaching day\u2014oh well, there\u2019s an e-module for that; you need to learn how to perform a simple procedure\u2014don\u2019t worry, there\u2019s a video for that; can\u2019t get to a clinic\u2014no problem, there\u2019s a PDF about what you may have seen anyway. Is work too busy to let juniors see the sickest patients under supervision? Never fear, there\u2019s a simulation day to cover that instead.<\/span><\/p>\n

The first example, of teaching days being replaced with e-modules, seems to divide opinion. This idea may be liked by trusts, as it\u2019s more flexible and doesn\u2019t require room booking, but I was surprised to find after recently discussing this with trainees that they like it too. They gave various reasons for this: not having to fight for leave, it being a more efficient use of time, some vague idea of it being \u201cbetter,\u201d not having to go to a venue they don\u2019t know, etc. And this is despite the trainees I asked being in a training programme that offers a surfeit of training days, and those days being almost universally rated as \u201cgood\u201d or \u201cexcellent.\u201d<\/span><\/p>\n

Yet, despite their endorsement, I can\u2019t help but think that they\u2019re losing out on other advantages that education in a face to face group add: it provides a forum for socialisation and for debrief, allows the session to be targeted to the audience and shaped by their questions and interactions, and opens up the opportunity for relevant off-topic discussion and pastoral support. Most importantly, I think, is that it allows for the normalisation of attitudes and behaviours with peers to take place, and for trainees to develop an awareness of how their experience, understanding, and knowledge compares to others. E-learning is very good at delivering facts and, indeed, for <\/span>preparing<\/span><\/i> trainees or students for facilitated teaching sessions (something known as the \u201cflipped classroom\u201d or \u201cblended learning\u201d), but they cannot replace real life experience, which is still a vital part in any education process. <\/span><\/p>\n

The final example, simulations of seeing sick patients, is an area that\u2019s evolved rapidly over the past decade and is generally viewed in a positive light by both those involved in teaching as well as by trainees themselves. Yet I think it\u2019s important to look at why it evolved in the first place. <\/span><\/p>\n

It wasn\u2019t all that long ago that a junior doctor was able to see actual sick patients and had an SpR (as it was then) or a consultant close at hand to discuss their case with and to run all decisions past. Now the seniors see the patient directly and so the opportunity for experiential learning is lost. Replacing it with simulation simply isn\u2019t the same (however much techno-positivist advocates say otherwise). <\/span><\/p>\n

Don\u2019t get me wrong, I\u2019m not remotely against simulations and think it can be an excellent resource, but I simply don\u2019t see it as a replacement for good old fashioned medical training and supervision. It seems to me that a lot of the present use of simulation is simply trying to fill in for the system\u2019s current deficiencies in training, which have been created by trainees being denied more and more the opportunities to do tasks that their predecessors did at the same stage of training.<\/span><\/p>\n

TEL undoubtedly has immense potential and a multitude of uses in medical education, but we need to be aware that it isn\u2019t a panacea. It\u2019s neither a replacement for high quality day to day supervision, nor should it be used instead of face-to-face teaching. TEL, as its name suggests, works best when it enhances or augments existing learning and teaching methods. Educationalists have to understand its uses but just as, if not more, importantly they have to understand its limitations in much the same way they did when computerised slideshows gained widespread adoption. Human contact, high quality mentoring, and supportive relationships have to remain the backbone of medical education.<\/span><\/p>\n

Matthew Roycroft<\/strong> is a leadership fellow working for the School of Medicine in Yorkshire and the Humber and an ST6 in geriatric medicine\/GIM on the RCP’s Trainees\u2019 Committee. All opinions are the author’s alone and don’t necessarily reflect the viewpoint of any other organisation.<\/em><\/p>\n

Competing interests:<\/strong> I have read and understood BMJ policy on declaration of interests and declare the following interests: None.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

TEL has many uses, but high quality mentoring and supportive relationships must remain the backbone of medical education […]<\/p>\n

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